Provider Demographics
NPI:1821893793
Name:ROOSE PERFORMANCE LLC
Entity type:Organization
Organization Name:ROOSE PERFORMANCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ROOSE
Authorized Official - Suffix:
Authorized Official - Credentials:CSCS
Authorized Official - Phone:239-247-0081
Mailing Address - Street 1:3335 GULF BREEZE PKWY STE 107A
Mailing Address - Street 2:
Mailing Address - City:GULF BREEZE
Mailing Address - State:FL
Mailing Address - Zip Code:32563-3351
Mailing Address - Country:US
Mailing Address - Phone:850-641-1172
Mailing Address - Fax:
Practice Address - Street 1:3335 GULF BREEZE PKWY STE 107A
Practice Address - Street 2:
Practice Address - City:GULF BREEZE
Practice Address - State:FL
Practice Address - Zip Code:32563-3351
Practice Address - Country:US
Practice Address - Phone:850-641-1172
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-15
Last Update Date:2025-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare